Catastrophic vision loss from radiation-induced optic neuropathy.
Sultan AldreesJonathan A MicieliPublished in: BMJ case reports (2020)
A 68-year-old woman presented with profound vision loss of 2-month duration in the right eye and 1-week duration in her left eye. This occurred in the context of craniopharyngioma that was twice resected and irradiated (54 Gy in 30 fractions) 9 months before her presentation. Ophthalmological examination revealed hand motion vision in the right eye and light perception vision in the left eye with poorly reactive pupils and bilateral optic disc pallor. A non-contrast MRI of the brain and sella showed significant reduction of the sellar mass. A repeat MRI of the brain and orbits with gadolinium showed pre-chiasmatic enhancement of both optic nerves. The diagnosis of radiation-induced optic neuropathy was made. Despite treatment with high-dose intravenous corticosteroids, 19 sessions of hyperbaric oxygen therapy, and 3 doses of intravenous bevacizumab, her vision worsened to no light perception in both eyes.
Keyphrases
- radiation induced
- high dose
- contrast enhanced
- radiation therapy
- optical coherence tomography
- magnetic resonance imaging
- white matter
- low dose
- computed tomography
- lymph node
- diffusion weighted imaging
- stem cells
- single cell
- clinical trial
- optic nerve
- autism spectrum disorder
- cerebral ischemia
- multiple sclerosis
- mass spectrometry
- prognostic factors
- study protocol
- brain injury